PrEP school

Daily use of drug to prevent HIV infection greeted with controversy

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Daily use of drug to prevent HIV infection greeted with controversy
AP PHOTO BY JEFF CHIU

Two weeks ago, the Centers for Disease Control and Prevention announced that it was recommending physicians consider Truvada, a medication used to treat HIV/AIDS, to prevent infection for high-risk patients who are HIV negative. Seen as a miracle drug by some and a "party drug" by others, Truvada has struggled to take off as a preventative measure and, prior to the CDC's endorsement, foundered under its own controversy.

The drug regimen is known as pre-exposure prophylaxis, or PrEP, and involves taking one pill of Truvada daily. The most common side effects are initial nausea and headaches, but even those generally subside after a couple of weeks. Most impressive is the efficacy rate: Studies point to a reduction in risk of contracting HIV that is higher than 90 percent for individuals who take the medicine daily as recommended.

Additionally, the CDC has recommended PrEP only for high-risk patients — meaning gay men who have sex without condoms; intravenous drug users; and couples, gay or straight, where one partner is HIV positive and the other is negative.

"While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today," said Dr. Jonathan Mermin, director of CDC's National Center for HIV/AIDS, in a press release.

But PrEP comes with its detractors, the most vocal of whom have come from within the HIV/AIDS and gay community. PrEP users often carry the stigma of being hypersexual gay men, looking to justify their promiscuous sex lives and disavowal of condoms with a daily pill. The label "Truvada whore" soon emerged as a means to shame PrEP users (though the term is now being reclaimed by PrEP activists as a source of pride through hashtags and T-shirts).

However, the loudest critic by far has been the AIDS Healthcare Foundation, a nonprofit organization based in Los Angeles that provides care to HIV positive patients around the globe.

"This is a position I fear the CDC will come to regret," said AHF President Michael Weinstein in a public statement. "By recommending widespread use of PrEP for HIV prevention despite research studies amply chronicling the inability to take it as directed, and showing a limited preventive effect at best, the CDC has abandoned a science-driven, public health approach to disease prevention — a move that will likely have catastrophic consequences in the fight against AIDS in this country."

The push for PrEP is playing out like a grand battle between two formidable foes. On one side is the multi-billion dollar pharmaceutical company that produces Truvada, Gilead Sciences, headquartered just a few miles south in Foster City. On the other is AHF, the largest provider of HIV/AIDS medical care in the US. While on the surface it may seem like a massive corporation taking on the not-for-profit underdog, the reality is much more complex.

 

THE TRUVADA TRAIN

When Truvada was first approved by the Food and Drug Administration 10 years ago, it was a revolutionary new pill used in combination with other drugs to help control the virus in HIV-positive patients. At a time when most HIV medications required taking pills throughout the day and carried intolerable side effects, Truvada was a once-a-day godsend.

Since then, Gilead has established itself as one of the leading companies for HIV medications, producing or helping to produce many top drugs, such as Atripla, Complera, and Stribild, all of which use components of Truvada in their formulas.

But Truvada's truly revolutionary moment came in July 2012, when it became the first drug approved by the FDA to reduce the risk of HIV infection in negative individuals.

Controversy immediately ensued.

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